This five year project proposes to evaluate alternative management pathways for patients with hip fracture and patients being considered for total hip replacement for osteoarthritis. These are two closely related procedures performed on a large percent of the elderly U.S. population annually. The ultimate goal is to provide accurate information to practitioners in order to improve quality of care and to optimize utilization of health care resources. The primary objectives of this project are: 1) to conduct studies to assess the effectiveness of alternative management options; 2) to construct management recommendations based on the analysis of these studies; 3) to widely disseminate these recommendations to practitioners; 4) to measure, where possible, the impact of these recommendations on practice patterns. To achieve the first two objectives, we propose to utilize a decision analysis approach defining alternative care management options. Outcome probabilities needed for the decision analysis will be estimated from data derived from: 1) a retrospective analysis of secondary data, using billing data on a five year 100% sample of 65 years and older Medicare beneficiaries undergoing hospital management of hip fracture and receiving total hip replacement for osteoarthritis in all Maryland hospitals from 1985-1989; and 2) a prospective analysis of primary data obtained through two parallel studies on separate cohorts of patients. A synthesis of the data from these studies will fill out the probabilities in the decision models and will provide the basis of recommendations for clinical management. To achieve the third objective, the recommendations will be disseminated via presentations at continuing education programs, presentations to individual hospital staffs, presentations at the meetings of the Maryland Orthopedic Society, journal publications, and a video production for lay public. The fourth objective, evaluation of impact, will be achieved through a series of studies using before and after analyses of medicare billing data, before and after analyses of process of care in the seven (plus one) hospitals, and before and after comparisons of physician attitude questionnaires.